BackgroundHealthcare students must learn to collaborate across professional boundaries so they can make use of each other’s knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students’ negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement.

MethodsThe study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice.

ResultsStudents relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student’s profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be ‘having time to negotiate or not’, as well as ‘feeling safe or not’.

ConclusionsFinal-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict. 

Collaboration across professional boundaries is an essential aspect of health care, and interprofessional education (IPE) is a common way to help increase students collaborative abilities. Research on how and when IPE should be arranged in a curriculum remains, however, inconclusive. How students actually develop interprofessional competencies have been difficult to demonstrate and is still an under-researched area. Studying IPE in context is therefore important to understand its full complexity. This paper examines how students work with scenarios from professional health care contexts when learning together in interprofessional problem-based learning tutorials during the first year of undergraduate education. The data are video-recorded tutorials of students from medicine, nursing, occupational therapy, speech and language pathology, and physiotherapy programmes. The analysis focuses on students discussing their readings of the literature. Drawing on "Communities of Practice," findings show that students discuss and connect professional knowledge, with "brokers" (the tutors) and "boundary objects" (scenarios) supporting the emergence of students professional knowledge. The scenarios, as boundary objects, also enabled the students to turn into brokers themselves. The paper contributes to research on interprofessional learning and offers support for implementing IPE in the early stages of undergraduate education.

Scientific advances, along with better conditions for attaining healthy lifestyles, have had the result that more people live longer. On the flipside of this success, people are also living longer with diseases and are thus in need of more health care than before. This takes up available resources and the health care system must adapt accordingly. One solution that has been put forward for this dilemma is interprofessional collaboration. Resources can be used more efficiently by collaborating across professional boundaries, and we can benefit from each other's competencies in a way that serves both the patient and the system better. However, being able to collaborate with colleagues of different professional backgrounds is not a given. Just because you have a healthcare education does not mean that you automatically know how to collaborate with others. Interprofessional education must therefore be offered to health care students so they can learn to collaborate at an early stage.  

In recent years, more research has been devoted to examining the nature of interprofessional education and what students do when they work together during different interprofessional education activities. However, since interprofessional education comes in many shapes and forms, research must continue with the endeavor to understand what students do during interprofessional learning activities. It is important to expand our collective understanding of the relation between how interprofessional education is arranged and the students’ learning. The thesis therefore focuses on the relation between how students enact interprofessional collaboration during different IPE-activities and the way the learning activities are arranged. I have paid attention to what the students do, what kind of knowledge they share with each other and how, how they negotiate tasks with each other and how they organize their interprofessional collaboration. In addition, the thesis is framed by a practice-oriented approach.  

The thesis is based on four papers, all of which have been conducted with a qualitative approach. Data consist of video-recordings and ethnographic observations. Three settings are included and serve as the foundation for the thesis. In total, data collection has been conducted seven times across the three settings and been combined differently in the papers. The analysis has been supported by different theoretical concepts linked to practice theory.  

Taken together, the papers show that health care students navigate in a landscape of practices. This landscape includes both profession-specific practices and practices shared among students from other study programs. As students learn, they travel through this landscape with their sights set on the goal of working in health care. To get there, they must relate to several different areas of knowledge, ways of doing things, traditions, parallel ongoing practices and much more. They need to navigate their way forward, and they get help from ongoing guidance and support. For example, supervisors help the students understand the practices, the rooms they are in, the scene for how to act, the tasks and the scenarios which show students what is in focus. Not least, students have each other. Through themselves they can connect and share knowledge in a way that enables them to also organize and enact interprofessional collaboration. However, at times they also encounter obstacles - resulting in them ending up caught in the middle of things, not sure what practice to find safety in. Collectively, this demonstrates the importance of consciously designing interprofessional education so that students benefit from all practices in the landscape. 

Background

Healthcare students must learn how to collaborate with colleagues from different professional backgrounds and organisational units. Research has showed what students themselves think they gain from interprofessional education. Less is known about what knowledge students share when doing interprofessional education.

Purpose

This paper aims to study students’ knowledge sharing when working together as an interprofessional team at an interprofessional training ward.

Method

The study was conducted using a focused ethnographic approach. Field observations were carried out at two different interprofessional training wards. Fieldnotes, drawings and informal interviews constitute data. Data was analysed iteratively with ‘practice architectures’ as theoretical lens.

Discussion/conclusion

We found that students share knowledge in different ways during ward rounds, at the student team room and during the reflection session. The ward rounds are more formal and structured; at the student team room, things are buzzing; and the reflection session is weary.

The patients role in interprofessional education is fundamental; however, it has received insufficient attention. This study explores how supervision facilitates and supports undergraduate students learning of patient-centeredness in interprofessional clinical placements. Data were generated in three clinical contexts based on a focused ethnography approach. We found that supervisors are engaged in student teams interprofessional learning, but often in their preparations or debriefings and seldom during patient encounters. The patient perspective is also less frequently scrutinized in planned interprofessional supervision sessions. Nevertheless, clinical settings provide numerous opportunities that may be exploited further.

As health care increases its focus on collaborative practice, universities must provide students with opportunities to learn how to collaborate with different professions and translate this knowledge into practice, known as interprofessional education. Simultaneously, researchers struggle to understand the full complexity of interprofessional education and must therefore conduct multiple-site studies, employ observational work, and apply theory throughout the research process.This paper draws on focused ethnographic fieldwork at two different sites focusing on how students organize collaboration during interprofessional clinical placements. Findings indicate that the way students organize their collaboration is intertwined with how patients were introduced during handovers and involved mobilizing knowledge as “betwixt and between” familiar student practices and unfamiliar clinical practices. Findings also show how authentic situations, artifacts and spatial features supported students to mobilize collaboration.

The first time that students meet for a problem-based learning (PBL) tutorial is important for setting the framework for the rest of the PBL process (Hempel & Jern, 2000). This occasion typically involves introducing themselves, meeting the tutor, writing a group contract, and starting work on the first scenario or case. When students are working in interprofessional groups—with peers from other educational programmes—there is the additional complexity of establishing common ground while maintaining one’s own professional focus. It is within this context of interprofessional health education that the current chapter is based. We provide a discursive analysis of the early moments of the first tutorial in which students introduce themselves to their fellow group members. The research question is: How do students present themselves in the first tutorial of a new PBL group in which they come from different professional programmes? In the remainder of the introduction, we situate this work within a broader theoretical and empirical context of work on interprofessional learning and communication, group formation, and academic identities.